Bio-identical hormones

Balanced hormone levels are essential for all aspects of health. Bio-identical hormone therapy is particularly important in mitigating the effects of hormonal imbalance that can occur as we age, as well as improving overall well-being.

Bio-identical hormones are derived from diosgenin, a substance obtained from Mexican yams. As their molecular structure is identical to those found naturally occurring in the body they are considered to be more effective.

Bio-identical hormone therapies (BHRT) are often used to help reduce symptoms caused by the fluctuations of hormones in the body, leading up to and during the menopause (in women) and the andropause (in men). They are also used to treat, premenstrual syndrome, polycystic ovaries, endometriosis, acne and other hormone related conditions.

We can compound the following hormones for your patients’ needs, which are usually administered as creams, lozenges or capsules containing one or more hormones:

Progesterone plays an important role in maintaining women’s health and well-being. It is also necessary for male hormonal balance. Progesterone imbalances may cause infertility, anxiety and irritability. Bio-identical progesterone can be mood-enhancing and works as a natural anti-depressant, bringing relief to symptoms caused by hormonal imbalances.

Estrogen is the name given to a group of related hormones: estrone, estradiol and estriol. Oestradiol and estriol are often prescribed together as biest (bi-estrogen) because they closely mimic the normal ratio of these hormones in the body. The main functions of oestrogen are to support women’s health and well-being. Synthetic estrogens, as prescribed in conventional HRT, are usually taken from the urine of pregnant mares and mixed with a sodium compound. Bio-identical estrogen, on the other hand is identical in its structure to the human hormones.

Benefits of bio-identical estrogen can include:

Reduction in bone loss: helps to reduce the incidence of osteopenia and osteoporosis.

Reduction in menopausal symptoms

Reduction in loss of collagen

Slowing down early atherosclerosis

Improvement in skin and hair condition

Reduction in symptoms of urogenital atrophy. Reduces nocturia and stress incontinence, if used systemically or topically

A positive effect on muscle repair

Improved verbal memory when used with testosterone / bio-identical estrogen.

Testosterone is the principal male sex hormone and also an anabolic steroid. During the ageing process, testosterone decreases and symptoms of andropause (male menopause) may be experienced. These include decreased libido, muscle weakness and loss of lean muscle mass, lethargy and depression. Women also produce testosterone in small amounts and both genders require it for building strong muscles and bone density.

Dehydroepiandrosterone known as ‘DHEA’ is the most prolific hormone in the body and starts to decrease from around the age of 30, matching the signs and symptoms of ageing and susceptibility to disease. DHEA converts into essential hormones; testosterone and oestrogen as required by the body. DHEA increases energy and enhances the feeling of vitality.

Pregnenolone is a powerful hormone and is essential for the production of both DHEA and progesterone within the body. It does not occur naturally in food. The human body generally makes enough pregnenolone to meet your needs, under normal circumstances. However, pregnenolone levels decline with age and supplementation is often beneficial.

Melatonin induces profound relaxation of muscles and nerves, which makes for better sleep. It also protects against free radicals. Physical signs of deficiency are poor sleep, excess of muscle tension, circadian rhythm disturbances.

Our Pharmacists are readily available via phone or email to work with you to offer expert guidance on bespoke prescriptions and formulations that are relevant to your patient’s needs

The maximum strength for each compounded bio-identical hormone is 400mg (100mg per quarter) in a lozenge and 100mg in a cream. In the event that you would like to prescribe a higher dose, you can contact our pharmacist directly. We will work with you to determine whether the new formulation is possible without compromising the quality of the medication, such as making the consistency too thick.

Transdermal Cream

If you are prescribing a cream for your patient, this will provide 160 doses in a 50ml tube, with each full pump providing 0.3ml.

Patients are advised to:

Press the pump all the way down to obtain the correct dose.

Apply the cream to clean, dry skin on the inner forearms or as directed by your doctor.

Rub in for at least one minute to ensure full absorption.

Replace the cap and store at room temperature.

Lozenge

Lozenges come in a tray of 30 full lozenges that have been scored and can be cut into 120 quarters. They are taken through the buccal and are absorbed through the mucous membranes of the mouth and should not be swallowed. A small amount of the lozenge will dissolve in saliva and metalbilise through the gut.

Patients are advised to:

Remove a single lozenge from the tray by pushing on the underside until the lozenge pops out.

Lozenges can be cut into quarters if directed by your doctor.

Place the lozenge between the gum and side of the cheek and and let it dissolve. Please allow up to 20 minutes.

Do not suck, chew or swallow the lozenge.

Replace the tray cover when storing lozenges.

Store at room temperature and out of direct sunlight.

Capsule

Capsules come in packs of 100; the size of the capsules make them easy to take. Each capsule is compounded specifically for the patient.

Patients are advised to:

Take their capsule with a glass of water.

Not suck or chew capsules.

Store the capsules at room temperature, out of direct sunlight and humidity.

Oral

HRT equivalent

BHRT equivalent

Brand name

Generic name

Dosage

Premique®

(Low dose)

Premique®

Conjugated equine oestrogens

Medroxyprogesterone acetate

Conjugated equine oestrogens

Medroxyprogesterone acetate

0.3 mg

1.5 mg

0.625 mg

5 mg

Prempak C®

Conjugated equine oestrogens

Norgestrel

0.625 mg 0.15mg

Ellest-Duet®

Climagest®

Oestradiol

Norethisterone

Oestradiol valerate

Norethisterone

1mg

1mg

1mg

1mg

Kliovance®

Oestradiol

Norethisterone

1mg

0.5mg

Femoston® Conti

Oestradiol

Dydrogesterone

1mg

5mg

Premarin®

Conjugated equine oestrogens

0.3mg

0.625mg

Elleste Solo®

Oestradiol

1mg

2mg

Transdermal: Patch and Gel

HRT equivalent

BHRT

Brand name

Generic name

Dosage

Patches

Estraderm®

Estradot®

Evorel®

Evorel Conti®

Oestradiol

Oestradiol

Norathistherone

25mcg/24hrs

50mcg/24hrs

75mcg/24hrs

50mcg/24hrs

170mcg/24hrs

Gels

Oestrogel®

Oestradiol

0.75mg

Sandrena® Gel

Oestradiol

0.5mg

As bio-identical hormones are identical to the body’s naturally produced hormones, side effects are minimal. Bio-identical hormones can be safely prescribed as individual hormones as well as a combination of active hormones. This makes it easier to fine tune each hormone to the requirement of your patient’s body, compared to the fixed formulations found in standardised medication.

It is not unusual if your patient experiences mild sensitivity to the medication during the course of their treatment. In this situation, please refer to your medical practice guidelines or speak to one our pharmacists.
In the unlikely event that your patient’s symptoms are severe and experienced out of your practice hours, please advise your patient to contact their GP or local hospital.

The Specialist Pharmacy is the first compounding pharmacy in the UK dedicated to the use of bio-identical hormones, creating bespoke medicines designed to treat the symptoms of the menopause and other hormone-related conditions. We are registered, regulated and comply with the standards of the General Pharmaceutical Council (GPhC). Our rigorously trained technicians work only with suppliers operating in countries whose pharmaceutical raw materials and GMP standards are recognised by the EU, using approved manufacturing equipment and software.